How do you know your gender?
I knew I was not a boy or a man. I've never felt that way.
I've always just identified as female.
Do you see yourself as male, female or somewhere in between?
Growing up, I couldn't understand why people put the label on me,
that I was a girl, because to me, I was just a boy.
Try to put me in a dress, I'd start screaming. Yeah.
Millions of people around the world do not associate with the gender
they were assigned at birth.
There's parts of the body which shouldn't be there.
My head has never really felt connected to my body.
And they want to do something about it.
In this film, we find out what it's really like
to transition your gender,
and what happens biologically and psychologically
through the eyes of the people who are living it.
The first time when you go out as a woman is such an alien thing to do
but, at the same time, it felt really right.
I feel like I'm just now beginning my life at 25.
Yes! What's that say?
Testosterone! Testosterone!
Testosterone!
We discover how science is trying to uncover the true nature
of gender identity.
What can we figure out about physiology, brain morphology,
that helps us understand
the formation of gender identity in anyone,
is a relatively new field of study.
While, at the same time, advances in modern medicine
are helping people to transition to the gender they identify with.
Some people sort of mistakenly think there's only one surgery
you can have if you're transgender.
Oh, my God!
Here we are!
I'm here!
I was probably about seven or eight years old when I realised
that something wasn't quite right.
But it took me a long, long time to really kind of put my finger
on what that was.
It was only one I was about 21
that I realised that I was trans and that I wanted to transition,
or needed to transition.
According to the sound codes, that's the fault.
That's what was causing the fault on the train,
so that's what I've changed today.
I'm a 24-year-old transgender women,
which means that I was assigned male at birth but identify as a woman.
I work as a rolling stock engineer for London Midland.
I started socially transitioning about 18 months ago.
I think social transition is probably the hardest part of transitioning.
It certainly requires the most guts.
It's where you have to stand out from the crowd and say,
"This is me, this is who I am."
It's a massive, massive step.
I wanted to be perceived as a woman, so I started wearing female clothes,
I changed my name.
I was quite nervous at the time.
It's such an alien thing to do,
the first time when you go out as a woman,
but, at the same time, it felt really right.
One of the first jobs I remember working with you
was changing a toilet level sensor.
So it weren't... Nice start to your London Midland career!
It wasn't a very pleasant job!
I was a bit concerned about coming out in a masculine environment,
but the other side of the coin was that
transitioning was kind of the most important thing to do.
The first thing I recall from higher management was a brief.
One or two people were a little bit apprehensive and unsure about how...
On the workshop floor, I think everyone was a bit apprehensive,
not because we were going to say anything inappropriate,
but in case we accidentally said something.
You've seen the banter that we have, you know.
They didn't want to offend you.
I think everyone's been really good, how accepting they've been.
Do you class yourself, then, as transgender?
I class myself as transgender, yeah.
So, as I understand, then, you're in the process...
When you have changed your gender, that's what you want to do?
So I'm going through a process at the moment to change.
But when that's complete, then you will be female?
Yeah. And not transgender, but you will be female?
Pretty much, yeah.
It'll probably take another 18 months to two years or so
to complete the process, including surgery.
When did you decide on this?
Is it just a decision or is it just something that grew on you...?
I don't think it's a decision
so much as almost a compulsion of something that you have to do.
So what happens then?
Excuse my ignorance, but you just go down the doctor's?
Pretty much. So I had to go to the doctor and he referred me
to the gender clinic and, about 13 months later, I had an appointment.
A lot of people like to get hung up on the medical side of transition,
but socially transitioning is the thing that's really made the biggest
difference to my life,
because it allows me to live authentically and be who I am.
Bend, and stretch.
And bend, and good.
Last one. Rise and lower, up and down.
Straight legs forward, and stop.
Straight legs backwards, and stop.
Stop in first position.
My name's Samantha.
I'm a transgender female.
For me, social transitioning was secretive.
The first time I was about 12.
I just happened to be in a situation
where I could go through my sister's wardrobe.
Everyone had gone out.
Very quickly, I had some of my sister's clothes on.
I slowly collected a collection of her things,
that she didn't notice were missing, under my bed.
And it became when everyone had gone to bed, then that was my time.
At the same time now so you've got both straight legs.
Dance for me was a means of escape.
My dance teacher was great.
Even from a young age, she allowed me to present as female.
It was good until my mum one day was going through my drawers,
tidying up, and spotted a drawer full of my sister's clothes.
And it was brought out for everyone to see and, you know,
thrown out on the floor in the living room, and I was shamed.
And it was taken away and they said,
"If you ever do this again, we'll tell everyone."
Around 18, 19 years old, I decided I was going to socially transition.
But, unfortunately, my parents clocked on...
...and they were not happy.
So they then had a choice.
I could be who I wanted to be, but I had to get away,
or I could stay where I was, but I could never be who I wanted to be.
So it was a very hard decision.
I chose life over my family.
Social transition definitely is the key to the whole pathway
before you've had the hormones,
before you've had all the other stuff.
You need that confidence to be able to stand up and be counted.
If you don't, then who are you as a person?
I realised that just wearing the clothes wasn't enough for me.
I knew I'd need to have some work done on my body,
I knew I needed some interventions, and I needed help.
I'm going to the gender identity clinic in Sheffield
to see Dr Coakley.
There is a huge demand on the services,
which can lead to very long waiting lists.
So you are waiting, you know, sometimes 18, 19 months,
just to see the first person to say,
"Yes, you are suffering from gender dysphoria, but don't worry,"
"we've got a solution for that."
Can you tell me a little bit about what your experience
of socially transitioning was, and the lead-up to it?
It's been mixed.
I think the main improvement was, obviously,
not having to live two lives.
How was your mood leading up to that decision?
I was lost.
The thoughts just spiralled down to, you know, why do I exist?
Gender dysphoria,
it's where my brain gender does not match up with my biological sex,
and the mix-up of the two can cause major distress.
Did you have thoughts about harming yourself?
Yeah, I've had a few suicidal attempts.
I knew that, if I didn't have the help, you know, within a year,
it probably wouldn't have been an attempt,
it would've been successful.
I'd never be fully accepted as female because I had a penis,
and it's something when you go outside, a lot of people comment.
There goes, you know, a bloke in a dress.
And there's only so much abuse you can take
from yourself and other people
before, eventually, life just seems to get easier thinking about dying.
It's been reported that as many as 40% of transgender people
have attempted suicide.
So when was it that everything moved forward for you?
Probably the last six months, really,
coming to terms with a lot more of my little demons themselves.
I'd carried this letter in my pocket for about a week.
I was too scared to give it to them.
You think you are going to get alienated for it
and lose all your friends and your family,
you hear all these horror stories.
One night after dinner, I ran through the living room,
dropped the letter on my dad's lap and sprinted upstairs.
So how did you feel when I came out?
I found it difficult to start off with.
Because I did feel like I was grieving a bit for a daughter.
And I took blimming ages to get used to pronouns, didn't I?
I got "Jamie" quick, but you were still a she for a good long while
before I managed to get my head around it.
The hardest thing for me was actually going to tell my parents,
that basically that of their four grandchildren,
their only granddaughter was now a grandson.
Yeah, a grandson, yeah.
And they found it very difficult. Yeah.
Because it's not an easy path.
The potential for transphobia, for discrimination and the like
is not something we would want you to suffer from.
I think back to when you were 14,
and you were self harming,
which was really the start of the depression,
whether you really knew then.
And obviously, you've had a couple of overdoses as well.
Now I'll always say to people, well,
it's kind of, for us,
It's better this way than not having you here at all.
What's the alternative?
A really important part of my transition will be getting
cross sex hormones which, in my case, is testosterone,
and that will mean that my physical appearance and my body
appear more masculine.
Developing raw outward male characteristics will become...
It will help you. It doesn't change who you are.
You're still the same character, you're still the same personality.
Or what we think of you. Or what we think of you. I'm going to cry.
We still love you.
Don't cry on camera!
It is a big thing for you to go through,
and you won't need the support, you deserve the support. Mm.
Yeah.
I've got the most amazing supportive family, like, I'm so lucky.
My best friend, Fletch, has been amazing
throughout the whole process.
I guess it helps that he's a trans-guy as well.
We should be getting testosterone at around the same time,
so we can kind of go through the process and the transition together.
I have always known I'm going to...
That's a goal of mine, to get onto it.
What are you most looking forward to? My voice. Yeah, the same.
And filling out. Obviously, a lot of things change, like your voice,
you fill out, you get straighter, as in... Like your body fat?
Your body doesn't curve. Body fat redistribution.
Yeah. That's it, yeah.
Facial hair, body hair.
Like, at 18 years old,
being the height I am and having the face I do, and the voice that I do,
is a deciding factor on whether people decide to call me she or he.
You build up to this moment,
and I think everybody around you expects it to be fixed.
Yeah. You're fixed, it's solved.
But that doesn't mean your depression goes away,
that doesn't mean those bad thoughts go away,
and testosterone isn't a quick fix.
You don't get a shot of testosterone and suddenly you're Mark Wahlberg!
You know I mean? It's not like that. It's a gradual thing.
A lot of the effects of cross sex hormones could be irreversible,
such as making you infertile.
I think, for me, something that I've thought about so much,
and we've spoken about it so much,
is that I have to make a decision on whether I want biological children.
And at 18, to make that decision is so hard.
There's a part of me that's like, am I going to be happy
after I've done everything,
or am I still going to be...? Is it never going to be enough?
Yeah, and that's I'm always thinking about.
Because, at the end of the day, we can't be birth gender.
You can pass, but you'll always know.
I'm just a guy. I don't want to be seen as a trans-guy,
I don't want to be treated as a trans-guy.
I just want to be treated as a guy.
I'm just an average 19-year-old man.
I started off by going out to trans-events that were on.
I met Tamsin through a mutual friend.
I met Pippa at an LGBT event.
For me, personally, I wanted to go and have hormones
because I think it's really important to physically be female,
as well as be perceived as female.
So how often do you take your oestrogen tablets?
I take them twice a day, one or two mg,
and they also started prescribing a testosterone blocker.
By changing the balance of oestrogen and testosterone,
that's what really feminises the body.
Have you started noticing any changes?
I've started to notice a bit of breast development,
which is really good and I'm really pleased about that.
And then I started becoming a lot more emotional about things
and crying a bit more.
Is that something that's going to continue, sort of,
for the duration that you take it?
It's pretty much female puberty
that a natal woman would go through in her early teenage years.
I started off really low and then they just gradually up it
because your body takes so much time to adapt.
Did you get asked the question about sperm donation?
Yeah, no, I stored my sperm. Yeah...
So that, when I want to have children,
when I'm in my 30s, then I've got my DNA.
How are you going to potentially... How would you progress that forward?
Where do you see yourself, sexuality wise, relationship wise?
So, I see myself as...
I think I'm probably a straight transgender woman.
I have had a couple of people say, "Oh, well,
does that mean that you're gay?"
And I'm like, "No, it means that I'm a woman."
"It doesn't mean anything about my sexuality."
One of my real bugbears is that people view sexuality and gender
just as one.
I think who you are attracted to and who you are
are two different sides of the same person.
There's that really good saying that brings it home for me,
is that sexuality is who you go to bed with,
but then gender is who do you go to bed as?
So do you think gender is from the brain,
or society, or the environment?
What forms gender?
Gender is quite biological,
but I think there's a social element to it as well.
For decades, scientists have been trying to uncover
whether gender identity has a biological basis.
And, at the VU University Medical Center in Amsterdam,
Dr Baudewijntje Kreukels has been conducting several studies
to determine whether this could be true.
We have a very long history of care for people with gender dysphoria.
And I was very much interested in...
In treatments and their effects on the brain.
Gender identity develops gradually in early childhood.
But how does it affect the biological, psychological,
social factors? We do not know.
If there are biological factors that could explain these feelings
in people with gender dysphoria, that's what we try to study.
There is a hypothesis formulated where the idea is that, somehow,
the brain has developed in a direction that is different
from the direction the genitals have developed,
or the rest of the body has developed.
And that this may be behind these feelings of gender dysphoria.
A group of male and female adolescent volunteers
were asked to perform a gender typical test,
which triggered certain activity in the brain, seen in an MRI scanner.
An example of such a task is the mental rotation task.
This is a task that is done differently by men than by women.
And the question here is, which of the two figures on the right
are rotations of the figure on the left?
For this example, the right answer is the first and third one.
The results from these participants formed the control group.
We looked if there is actually a difference in their activation
in the brain when they perform this task.
And what you see here is that all the red areas
are where there was a difference in activation
between the control girls and control boys.
Then they repeated the same task with trans-boys,
birth-assigned girls with gender dysphoria.
When these results were compared to the control boys,
they showed a remarkable similarity.
You see that these areas, the blue areas are overlapping.
And in that way we could say that girls with gender dysphoria
were more similar to their gender identity,
so they were more different from their sex assigned at birth.
The study showed similar results with trans-girls.
This early evidence points to a shift from traditional thinking
that gender identity is a purely social construct.
I think the findings up till now certainly show us that there are
biological correlates, and there might be a biological basis
for these feelings.
For decades, the Netherlands has been at the forefront
of research into gender dysphoria.
And one controversial area they've pioneered
is the treatment for transgender adolescence.
Something that was noticed here in the '90s of the last century
is that psychotherapy was not helpful
for any alleviation of the gender dysphoria in these adolescents.
So, they thought, maybe we should think about
if we can start somewhat earlier with puberty suppression.
Puberty is temporarily stopped, it is a reversible treatment.
We can provide this treatment
so they have more time to come to a balanced decision.
An increasing number of people around the world
feel from an early age they are the wrong gender,
and decide to suppress puberty.
You were never into Barbies and dolls,
and never liked anything that his friends, girlfriends, were playing.
Whenever we went to Walmart to go shopping,
I liked going into the boy's section.
He wanted the short hair.
She's like, "No, you have long hair."
He had beautiful long blonde hair.
So I was like, "We're not shaving your beautiful hair off!"
He was skateboarding just out here...
Making a YouTube video.
And he introduced himself as Luke.
I saw the video.
And asked him if he wanted us to call him by "he" and "Luke".
And he said yes.
And so that's when we just changed everything over
and it was very natural.
I wasn't shocked. I was kind of just relieved to know,
OK, so this is how he feels and I can help him now.
I said, there's a medicine you can take
that'll stop your breasts from developing and stop puberty
so you won't get a period and all of that.
And he was, like, "Really?"
"OK, can I get them? When can I get them?"
And, um, that's when I found Dr Olson.
And...
I'm very happy we ended up there.
In 2006, it was really the Dutch who said,
"Hey, wouldn't that be interesting, if we could not
"have this puberty process," and people would not get
those secondary sex characters that cause so much distress
that then later have to be altered through surgical means.
This idea that we could keep people from this torturous experience
of this wrong puberty - like, keeping kids from dying,
keeping kids from self-harm,
keeping kids from being hospitalised - is magical.
We've been doing work with transgender youth
since the early '90s.
The youngest kid that I've seen here around gender
and gender-related situations is three.
Welcome back.
Luke has never been into anything girlie ever.
He's always liked to play rough, play outside, skateboard...
Every time you tried to put me in a dress, I'd start screaming.
Yeah. It was a fight. When you were little?
Yeah.
How old are you now? 11. You're 11.
Can we talk about puberty?
Do you remember how old you were when you started
to get chest development?
Probably by the end of fourth-grade it started.
And he was mortified by it, cos what boy wants to have a period?
They had the video at school, and he was, like, "That's going to happen?"
After the video, I'm, like, "It's too detailed!"
He couldn't wait. All summer, that's all he could talk about.
"When am I getting my blocker? When am I getting my blocker?"
In the things that I think have changed the landscape of trans-care,
I think blockers have been one of the most important tools
that's been introduced in the care of trans-youth.
But when we say blockers, it is a misrepresentation, really,
of what's happening.
He was pretty moody before the transition,
and pretty mopey all the time.
All of us, when we start puberty,
there are cells that mature and start secreting
something called gonadotropin-releasing hormone.
And that is a chemical signal to make the hormones
that stimulate either the ovaries or the testicles.
But another important piece to understanding this is that
gonadotropin-releasing hormone, or GnRH, is secreted in pulses.
When we are using blockers,
we're using that gonadotropin-releasing hormone,
but instead now we're giving it to somebody steady-state,
so we're injecting it or putting it in an implant.
And whenever anything is in a steady-state
that usually comes out in pulses,
the receptors on the pituitary gland become insensitive.
They gonads don't make sex steroids, and it's like a pause button.
It has really, really improved.
It flattened out the breast tissue a lot.
And it's just nice to see him happy.
We know that for people who go on blockers, those blockers
when they come off, if that person was going to go through
their puberty process that their body would dictate,
they would pick that process up in about six months or so.
Some people say he's too young to know or it's a phase or whatever,
and I say, "Well, to me it doesn't matter what gender he wants to be."
He's alive, he's happy, he's healthy,
and I'm happy he's able to be himself.
Some people mistakenly think there's
only one surgery you can have if you're transgender.
For me, it was most important to get my face done first.
And, of course, after that, the next thing's my voice.
35-year-old Sarah is a trans-woman from Brighton.
She lives with her wife, Eleanor, and their daughter.
Here she goes.
I'm going to Seoul in South Korea to have voice feminisation surgery.
Dr Kim is going to do this amazing procedure
that he sort of pioneered, which is kind of non-invasive,
it doesn't leave scars from the outside or anything like that.
Shall we do a high-five?
And this one.
People do travel from all over Europe and America to go and see him
because his work speaks for itself.
Quite literally.
Hello!
Look at that.
Do you not want any fish?
Eleanor and I met at a college party in 1997.
Can you eat that with chopsticks? OK.
About a year into our relationship, Sarah introduced it.
It's nice.
I just didn't hide who I was, essentially.
She could see female,
and she was always amazing about and it was essentially not an issue.
It was obviously something she had to do to...
to make herself happy.
We're just a family like any other family,
and it's not that we do anything any different.
We love and support each other.
My daughter's never known any different.
She's always know who I am and I'm just her parent.
She's got two mums and, you know, it's had no impact on her.
After the surgery, I think the voice would fit how she feels she is
and how I see her better.
I think for trans-people, you don't want to be
mislabelled, essentially, and your voice is another thing
that can help mislabel.
Hi, hi, Sarah. Lovely to meet you. Nice to meet you.
How are you? Yeah, fine, thank you. Have a seat, please. Thank you.
So, how does raising the pitch actually work?
The rainbow is a division of white light
into many beautiful colours.
Oh, wow.
The rainbow is a division of white light
into many beautiful colours.
Rainbow passage.
When the sunlight strikes raindrops in the air,
they act as a prism and form a rainbow.
I think they're going to assess my voice this afternoon.
I'm not really sure.
I don't know if it's just going to be a talking thing
or if they're going to put my head in a giant machine or something.
It could be anything.
Close your mouth and breathe through your nose.
OK, great.
Aah...
Very nice, OK.
Aah...
Oh, my God.
Very difficult?
Just relax. Everything is fine, don't worry about that.
Except for this stuff.
Chin up, please, OK.
Watch me, please.
My brain's saying, "Just do not gag"
"when there's a big cylindrical tube down your throat"
"and just make the noises they want you to."
My body's saying no.
OK. Oh, my God.
OK?
OK, OK. Just swallow one or two times, swallow.
Please understand, we have to do it.
Our procedure is very precise.
OK. So it's a very important thing.
Yeah, I understand. I will do it.
It's just difficult.
It is, sort of, I guess, extreme in a way, but I sort of think
more into the future about, then I'll have this new voice
and all that kind of thing. I'm just sort of thinking of that,
which is what keeps me in the chair and not running off.
So, did you get that bit?
Is that bit OK? Yes, it's OK.
And at the very least, it's a day out, gets you out of the house.
Before anyone's born, the first thing everyone wants to know is -
what gender is this baby? Is it a boy? Is it a girl?
And from that stage,
it's almost like their kid's entire life is set out for them.
For me, personally, I felt like I was invisible.
So people would talk to me,
but they weren't talking to someone I identified with.
It would be like this for anybody.
Imagine being called the wrong name your entire life,
or if you're a girl, imagine being called a guy when you're not.
It's like being in a prison for a crime you didn't commit.
Dr Marci Bowers is a surgeon based near San Francisco.
She specialises in gender confirmation surgery.
Transgender patients come from all over the world to see her.
We are specifically dealing with the genitals.
We're converting either male to female or female to male.
I do both.
The male to female's what I do most of.
I perform about 150 per year.
So that's pretty much one every other day.
If you look at it that way, which is kind of an extraordinary number.
The surgery each and every time is just very complicated and intricate.
And, so, to be able to put it all together
and then make it look pretty,
it's actually really... It's a great honour to do.
For me, it's doing, like, body art.
I have a history of having been through this change process myself
back in the 1990s.
I was the first person with a transgender history
to actually perform the surgery, in the world.
At the time, I was the head of the gynaecologist department
of OB/GYN in Seattle at the Swedish Medical Center,
which is a very high-profile position.
So it was a very big deal when I transitioned
because it just shocked people. You know, it was...
It was... It was a time when it was still very hard
to come out like that.
I'm still married, actually, to the same person.
And we've sort of...
Our relationship has transitioned into one more of a sisterhood,
I guess I would call it,
where we're best friends,
but we have three kids together.
My spouse and all of my kids have been fantastic from the first day.
I've wanted the surgery done since I was about 14 or 15.
I'm just glad that Marci Bowers is performing it.
That's so cute. Oh, my God.
I want that right there.
Oh, my gosh.
Isn't that cool? Oh, my God, Little House On The Prairie!
OK, so I guess I'm going to try on some of these dresses. OK.
I remember that you loved to try on really pretty, dressy stuff.
And how young was I?
About two. I mean, you could tell how happy it made you
whenever you could try things on that were beautiful.
I just have always felt like a normal girl since I was,
like, four or five.
Does this look OK, Mother?
Oh, that's really pretty!
Do they have a bigger mirror?
Oh, that's beautiful, honey.
We're so excited to be here finally.
Oh, my gosh. We're here!
It's been such a long road.
Thank you for getting me in.
What is the process?
It's a little bit like Mr Potato Head,
or Miss Potato Head. Sweet!
From some of the scrotal skin, we graft that
and that becomes the vagina.
And that's attached to part of the inverted penile skin.
But the other part that's really important is
that I don't like scars.
And so we've really been very strident
at trying to minimise scarring by hiding the incisions,
by pushing them off into the groins, that when you're standing
in front of a mirror, you don't see a scar.
All right, so we need to do an exam.
Let's have you jump over there, if you don't mind.
Deep breath, please.
Good.
I pronounce you fit as a fiddle.
Yay, I'm a fiddle!
What does this surgery mean to you?
I mean, it's been eight years in the making.
Well, it's actually been, like, 20 something years in the making.
I've always known I didn't want the parts I had,
I just didn't know what that meant.
Do you think that I had kind of...
suspected...? I mean, here I was raising a son,
and all of a sudden...
there was a lot of pink in the house.
And all of a sudden, you left the Tonka trucks
in the back yard to rust, and you just wanted Barbies.
And, you know... What did you think?
Like, how did you really feel when that was going on?
Because that went on for the rest of my life.
At first, I was a little bit...
insecure about it, so I just thought,
"Well, you know, I don't have to make a big deal out of it."
I knew I was not a boy or a man, I've never felt that way.
Sometimes people refer to it as losing a son, gaining a daughter.
And that's very true, because, I mean, I had the best of both worlds.
I had you, when you were just a young child, and then later on,
in your transition, I got a beautiful daughter out of it.
So, how cool is that?
I feel like...
I'm just now beginning my life at 25, getting my surgery.
I feel like that's all I've ever thought about
and stressed out about, is me being transgender
and having the wrong parts.
I am the happiest I've ever been in my life, because I waited...
...for something I thought would never be possible, my transition.
I have come this far to get my gender reassignment surgery
just so I can finally consider myself a girl,
because I've lived so long being considered a boy from everyone else.
I feel that this is the right decision
and will completely change my life.
For me, in my transition, I'm going to be taking cross-sex hormones,
which is testosterone,
which will have a masculising effect on my body.
Having a good support network whilst you're transitioning
is so important.
My best friends, Fletch and Grey,
have been amazing throughout the whole process.
Hiya. How are you? I'm good. You? Hello. Hello.
Lisa from the LGBT centre, we call her the Fairy Trans Mother.
She fights our corners at school, at work.
She's just a complete godsend.
So I've got my first ever testosterone shot today,
which is exciting.
Taking testosterone or any cross-sex hormone is never
an easy choice to make.
You will have to take the injections for the rest of your life.
For me, it's all about making my body match my head
as much as possible.
Because that bit of your body,
it shouldn't be a bit bigger or a bit smaller or whatever,
it just should not be there. Yeah.
Like, particularly, like, chest and stuff, it just should not be there.
That's not me.
So, getting hormones, like, it won't get rid of the problem completely,
but it helps you so much in being able to deal with it.
Hiya. I'm going to...
I'm here to pick up a prescription.
Thanks. Cheers. Thank you. See you.
My testosterone.
I'm excited.
I'm a bit nervous, but I'm excited.
Yes. What's that say?
Testosterone. Testosterone.
Testosterone.
It actually says it on the top.
I can't wait. That's the best thing.
Because people look at me and go, "You all right, mate?"
And then I start talking, they're like, "Oh, sorry, love."
James...? Yeah.
Jamie, are you going to get onto the couch for us?
Yes. I can. Will I just lie on my side, then?
Yes. You just need to lean here.
I'm just going to wipe your skin first.
Yeah, that's fine. OK.
Shot coming up now. Yeah.
Nearly done.
All done, Jamie.
Thank you. Cheers.
That's amazing. That's awesome.
I'm on testosterone.
I'm just buzzing.
I'm going to be on a high for, like, a week now.
You're going to be on a high for four weeks until
you have your next shot. Yeah, then I'll be on a high again.
Come on, Lisa.
The feeling is so hard to put into words.
You've finally got the right chemical in your body
and you know that this is going to make you into the person
that you are. It's just a massive relief.
Birthday hairdo.
It's not funny.
Hi, good morning. Hi.
How are you? I'm OK. Just OK.
You should avoid any caffeine...
Caffeine... alcohol. Yeah.
And shouting...
OK... screaming, singing.
OK.
So don't get drunk and then start singing and shouting today.
Yes. OK.
But it's my birthday.
OK, OK. Happy birthday.
Is that all right?
This is the oxygen mask.
Take a deep breath, please.
Slowly and deeply, please.
Open your eyes.
OK.
Here.
It's very important for the first month not to talk
or it can undo the surgery, and that's not just talking,
that's coughing, sneezing, laughing.
So how are you feeling?
So not too bad.
Love you too.
Hello. Hello.
Hi, good morning, you two.
How are you? Good morning.
Your hair looks great.
How are you doing? I'm doing well.
I didn't wear my extensions today, screw that.
It's OK. So this is going to be a great day.
I'm so excited. This is your big moment, right?
This is really exciting, yeah.
I'm not even nervous at all.
I have the best job in the world.
Somebody called me the Georgia O'Keeffe of genitalia.
I love it. I feel like I am going to have a designer pussy.
Oh, well, OK.
Is this like the Louis Vuitton of vaginas that I'm going to?
Well, we don't put initials on them, though.
Basically, I'm your canvas.
I'll come out and say hi to your mom afterwards.
I love you, Mom. I love you too. Everything's going to be fine.
Well, I'm a little nervous for you, but...
Well, all right. OK.
Thank you. You're welcome.
Here we are. I'm here.
Not all trans people are the same,
not everyone's end result is surgery.
But for me, personally, I'm just ready to have it done
and feel like how I imagine how I wanted
to feel my whole life.
After my surgery, I just feel like I'm going to be a girl.
I can do all the normal things that I felt like I should
have been able to do over my life that I haven't been able to do yet.
Like wear a bikini.
The surgery works well, because we all start from the same parts.
Everyone starts in female anatomy,
so the ovaries start from the gonadal ridge, and if they drop,
they become testicles, and if they don't they become ovaries.
And same with the clitoris.
It's really just a very short penis.
And when you're converting male anatomy to female anatomy,
you're simply reversing embryology.
What Dr Bowers is about to is an extremely delicate operation.
It involves the removal of the testicles and restructure
of the penis into a vagina.
What follows is extremely graphic in nature.
All right, so the operation begins by excising the scrotal skin.
There's so much ignorance about this surgery,
and there are people who actually liken it to,
you know, having a fetish for cutting your arm off
or something ridiculous.
And it has nothing to do with that.
We really do use every single part.
The scrotum is opened so that it can form the labia majora
and labia minora, and then part of the scrotum is also
used to line the vagina.
We take off the testicles, those we throw away.
She's got a couple of nuts on her, doesn't she?
It's quite sizeable.
We're going to get the clitoris from the head of the penis.
This is quite amazing, that we create a functional clitoris,
because these patients are able to have regular sexual sensation
to the point that most of them are able to orgasm.
The amount of erectile tissue is reduced in amount.
Obviously, the penis is on a longer stalk, if you will.
We just fold it over.
But if you keep the nerves and the arteries intact, there is sensation.
Now we're going to pick a position for the clitoris,
which will now rest in its final position.
All righty, then. So, clitoris is all in place.
We just have to dig the vaginal tunnel.
This is the most difficult portion of the procedure.
So, we're creating a space now between the bladder and the rectum.
And now those are scary structures,
in the sense of having significant blood supply.
If you incur injury to any of those, it can be a problem.
See, that wasn't so bad.
I'm going to go over and prep the graft.
And we are going to get this over our stint now.
And then I just become one of Cinderella's helpers here.
We just stitch and sew, and the next thing you know,
we've created the vagina.
Out of a scrotum. Who knew?
It's amazing what you can do with a scrotum.
They're really very useful.
There are hair follicles here,
which we're going to have to treat individually,
because you don't want these hairs to grow internally.
OK. Hand me the dilator.
It's not bad.
Yeah. It's pretty good.
OK. Let's go with that.
Now we're just finishing the clitoral hood.
The cosmetic parts of this are just so detailed.
And this is the most interesting part of it,
because this is where it really all comes together, so...
It's really... It can be quite gratifying.
All right.
Hello. Hello. Hi, good morning, how are you?
Good morning. I'm wonderful. Fantastic.
I have a vagina now!
Yes, you do.
And a glorious one at that.
Yay!
OK, OK. So, Vinnessa, we're going to take a look at your surgery.
Yay! So that's exciting.
Let's just see... Oh, I'm scared.
You can kind of get some of an idea here.
You see any of that? Oh, wow!
That's amazing! Yeah.
Is that me? Yeah.
So, when it goes down, you'll get a real better idea of that.
Oh, my God, it's going to look so good!
Yeah, yeah, yeah, yeah. Yeah. Yeah, yeah. For sure. Oh, my God.
I'm going to run. OK. Oh, my God! Thank you! I have a clitoris!
You're welcome. Yay! Oh, my God!
You're amazing!
OK. Thank you. Bye.
See you tomorrow. Thank you.
Mom... Yes, dear? ..I have a vagina.
Hallelujah!
I just feel content.
Like, now I can finally go out of these walls
and go back to Washington and...
...I can do whatever the hell I want. I have no restrictions.
Everything in nature is represented by a spectrum.
And it is really not surprising that there's a spectrum
of internal gender identity.
It's biological, it's not a psychological problem.
There is no test for your gender,
there's no online quiz to find out your gender.
There's no specialist doctors telling you what your gender is.
The only person who knows what your gender is, is you.
I don't believe transgender is one thing.
It's like anything, really.
Sexuality's a spectrum, so is gender.
I don't think even the most masculine men
or the most feminine women can ever claim to be entirely one gender.
I think it's a spectrum that goes from masculinity to femininity,
and I think everyone fits in a different place.
Since I've had surgery, it's given me a lot more confidence.
It's kind of the sort of final missing piece of the puzzle,
if you like. So that my voice matches how I look
and who I am and who I've always been.
I don't think that anyone else's gender is something
that you should even have an opinion on.
It's just something you should respect.
Embrace them for who they are, as everyone else does for you.
♪ I won't take the easy road
♪ The easy road, the easy road
♪ Show me my silver lining, I try to keep on keeping on
♪ Show me my silver lining, I try to keep on keeping on. ♪